Objective:To evaluate nutritional status and to analyse risk factors of acute exacerbation of chronic obstructive pulmonary disease (COPD) in the elderly.Methods:Data of elderly hospitalized patients with COPD mainly from 5 grade A, class 3 hospitals (Beijing Hospital, Shanghai Huadong Hospital, Tianjin Nankai hospital, the Second Affiliated Hospital of Medical College of Zhejiang University, Guangzhou First People′s Hospital) from January 2012 to December 2020 were retrospectively analyzed. According to the global initiative for chronic obstructive lung disease criteria (GOLD), elderly COPD patients were divided into acute exacerbation group and stable group. The differences in age, gender, medical history, anthropometry, laboratory examination, nutritional support, results of nutritional risk screening 2002 (NRS2002) and global leadership initiative on malnutrition (GLIM) were compared between the two groups after admission, and the risk factors of acute exacerbation of COPD in the elderly were analyzed by multivariate Logistic regression.Results:A total of 339 elderly patients with COPD aged 65-100 years were included in this study, including 177 cases (52.21%) in acute exacerbation stage. The detection rate of malnutrition in acute exacerbation stage was higher than that in stable stage (51.98% vs 41.98%, P<0.05). The weight, body mass index and grip strength of patients in the acute exacerbation stage were significantly lower than those in the stable period [(55.47±8.42) vs (60.63±9.30) kg, (20.52±4.25) vs (22.39±4.57) kg/m 2, (12.32±4.21) vs (16.59±2.97) kg] (all P<0.05). Spearman correlation analysis showed that the acute exacerbation of elderly patients with COPD was positively correlated with malnutrition ( r=0.443, P<0.001), and negatively correlated with body weight, body mass index and calf circumference ( r=-0.200, -0.214, -0.135, all P<0.05). Multiple Logistic regression analysis showed that acute exacerbation in elderly patients with COPD was only related to malnutrition ( OR=7.799, 95% CI: 4.466-13.622, P<0.001). Conclusions:The incidence of malnutrition in acute exacerbation stage of elderly COPD patients is high. Malnutrition is independently related to acute exacerbation of COPD.

Objective:To use the Global Leadership Initiative on Malnutrition(GLIM)criteria to assess the incidence of malnutrition in hospitalized elderly stroke patients, and to investigate the correlation between the criteria and clinical outcomes.Methods:A cross-sectional study was conducted from March 2012 to August 2021 to evaluate malnutrition in 658 elderly stroke inpatients aged 65-92 years, the GLIM criteria were used, and the correlation between the criteria and clinical outcomes was explored.Results:Of the 658 patients, men showed higher values in height, weight, Bady mass index, upper arm circumference, calf circumference and creatinine(all P<0.05), but lower total cholesterol( P<0.05). The incidence of malnutrition diagnosed with the GLIM criteria was 9.12%(60 cases). Based on the GLIM criteria, those with malnutrition had lower weight, Bady mass index, upper arm circumference, calf circumference, albumin and total cholesterol(all P<0.05), while age, duration of hospitalization, infectious complications and mortality was higher than those without malnutrition( P<0.05). Using the mini nutritional assessment-short form(MNA-SF), 14.74%(97 cases)of the patients had malnutrition.Results from the GLIM criteria and the MNA-SF were moderately consistent(sensitivity: 59.4%, specificity: 100.0%, positive predictive value: 100.0%, negative predictive value: 93.1%, Kappa=0.712). Malnutrition diagnosed with the GLIM criteria was associated with a longer duration of hospitalization( OR=1.022, 95% CI: 1.005-1.039, P<0.01), increased infectious complications( OR=16.614, 95% CI: 8.130-33.952, P<0.01), and increased risk of death( OR=2.810, 95% CI: 1.393-3.548, P<0.05). Conclusions:The incidence of malnutrition in hospitalized elderly stroke patients based on the GLIM criteria is lower than that based on the MNA-SF, and malnutrition is associated with adverse clinical outcomes.

Objective:To investigate the correlation between phase angle and muscle mass reduction in elderly diabetic patients.Methods:This paper retrospectively collected and analyzed the data of human composition and laboratory index in elderly patients with diabetes(n=106)and non-diabetic(n=153)patients in the Nutrition Department of Beijing Hospital, compared the differences between two groups, and explored the correlation between phase angle and muscle mass reduction in elderly diabetic patients.Phase angle was detected by bioelectrical impedance which was calculated as reactance/resistance× 180/π.Results:Phase angle was lower in elderly diabetic patients(5.17±0.65)°than in non-diabetic elderly patients(5.37±0.76)°( t=-2.075. P<0.05); age and fasting blood glucose were higher in elderly diabetic patients than in non-diabetic elderly patients(all P<0.05).There was no significant difference between the two groups in body mass index, fat, body fat percentage, visceral fat area, skeletal muscle index, body cell mass, total protein, albumin, and hemoglobin(all P>0.05).Correlation analysis results showed that in elderly diabetic patients, the phase angle was negatively correlated with body mass index( r=0.288, P<0.01), age( r=-0.680, P<0.01), was positively correlated with skeletal muscle( r=0.477, P<0.01), skeletal muscle index( r=0.505, P<0.01)and hemoglobin( r=0.382, P<0.01); and in the elderly non-diabetic group, phase angle was negatively correlated with age( r=-0.666, P<0.01)and positively correlated with body mass index( r=0.296, P<0.01), skeletal muscle( r=0.504, P<0.01), fat free mass( r=0.161, P<0.05), skeletal muscle index( r=0.441, P<0.01), body cell volume( r=0.496, P<0.01), and hemoglobin( r=0.420, P<0.01).The bioelectrical impedance apectroscopy detected skeletal muscle mass index<7.0 kg/m 2 for male and<5.7 kg/m 2 for female were used as the diagnosis standard for reduced muscle mass.The detection rate of muscle mass reduction was higher in elderly diabetic patients(17 cases, 16.04%)than in elderly non-diabetic patients(12 cases, 7.84%, χ2=4.229, P<0.05).The results of multiple regression analysis showed that the decrease of muscle mass in elderly diabetic patients was related to low phase angle( OR=0.413, 95% CI: 0.280-0.973, P<0.05)and aging( OR=2.174, 95% CI: 1.574-3.003, P<0.01). Conclusions:The phase angle is lower in diabetic elderly patients than in non-diabetic elderly patients, and the incidence of muscle mass reduction is higher in diabetic elderly patients than in non-diabetic elderly people.Decreased phase angle and increased age are related to the decrease of muscle mass in elderly diabetic patients.

Objective:To analyze influencing factors for sarcopenia in people of advanced age, in order to provide insight and evidence for the prevention and treatment of sarcopenia in people belonging to this age group.Methods:Data from 167 people of advanced age seeking care at our department from December 2014 to July 2017 were retrospectively analyzed.According to the diagnostic criteria for sarcopenia of the Asian Working Group for Sarcopenia, subjects were divided into the sarcopenia group( n=46, 27.5%)and the non-sarcopenia group( n=121). Differences in body composition, energy intake, quantities and proportions of three major nutrients were analyzed between males and females.Related influencing factors for sarcopenia were analyzed by using multiple linear regression. Results:Compared with the non-sarcopenia group, the sarcopenia group had lower body mass index, waist-hip ratio, fat mass, total energy intake and protein( P<0.05)but higher age and fat intake( P<0.05). Values for grip strength, muscle mass, index of skeletal muscle, adjusted muscle mass by body mass index, total energy intake, carbohydrates, fat and protein were lower and the percentage of body fat was higher in females than in males( P<0.05). Multiple Logistic regression analysis showed that insufficient intake of protein( β=-0.290, OR=0.748, 95% CI: 0.569-0.984, P<0.05), reduction of body fat mass( β=-2.673, OR=0.069, 95% CI: 0.010-0.488, P<0.05)and excessive visceral fat accumulation( β=0.739, OR=2.094, 95% CI: 1.219-3.597, P<0.01)were correlated with sarcopenia in people of advanced age. Conclusions:The occurrence of sarcopenia is higher in people of advanced age and is related to insufficient intake of protein, reduction of body fat mass and excessive visceral fat accumulation.Individualized nutrition evaluation and support should be carried out as early as possible for people in this age group.

Objective:To analyze the prevalence of malnutrition in stable-phase elderly patients with chronic obstructive pulmonary disease (COPD) using the Global Leadership Initiative on Malnutrition (GLIM) criteria.Methods:Using cross-sectional survey, 60 elderly patients with COPD in stable phase were investigated, with 72 elderly patients without COPD in the same age group selected as controls. Differences in basic characteristics, anthropometric indicators, hematology indicators and body composition were compared between the two groups. According to the GLIM diagnostic criteria for malnutrition, the first step is nutritional risk screening, the second step is to diagnose malnutrition, and the third step is to determine severe malnutrition. The prevalence of malnutrition and severe malnutrition were investigated.Results:The levels of total protein, albumin, creatinine, and lymphocyte percentage in the elderly stable COPD group were significantly lower than those in the control group. The nutritional risk and the prevalence of malnutrition in elderly COPD patients were significantly higher than those in the control group, and the prevalence of severe malnutrition was higher .Conclusions:Elderly stable COPD patients of different age groups have a higher nutritional risk. The onset age of malnutrition is younger than that of non-COPD patients and early intervention is required.

Objective To investigate the predicting value of serial serum human stromelysin-2 (ST2)testing on prognosis in elderly patients with acute heart failure(AHF).Methods 75 AHF patients aged 60 to 90 were selected in our study who were in Beijing Hospital during 2013.1 ～ 2014.8,blood sampling of serum ST2 took place at admission and 72-96 h later.Moreover,38 healthy people aged 70 to 80 were chosen as control group.Follow-up was performed 1 year after acute attack.We defined the end of observation as recurrence of heart failure or any cause of death.The data was analyzed by SPSS19.0.Results Among 55 AHF patients,sST2 level was higher in patients with endpoint events than those without it on the two moment(P=0.000).And we found that the change in sST2 was higher in patients with endpoint events than those without it(P=0.023);and the percentage change in sST2 was also significantly different(P=0.033).Receiver operator curve analysis of the change in sST2 from baseline to 72-96 h later was strongly reflective of prognosis with area under the curve(AUC) of 0.696(P=0.013).And the change in sST2 Combined with the sST2 level at admission to predict the prognosis of AHF,the result would be more exciting,the area under the receiver operating characteristic (ROC) curve is 0.861 (P ＜ 0.001).The endpoint event rate of the patients whose level of sST2 at admission was below 1408 ng/L and the change level in sST2 below 101 ng/L was 21.4％(3/14),while the data in patients whose level of sST2 at admission is above 1 408 ng/L and the change level in sST2 above 100 ng/L was 85.7％(12/14).Conclusions in elderly patients of AHF,sST2 elevate markedly.The result shows that the level of sST2 may be used to evaluate AHF prognosis.And the change in sST2 are able to predict the prognosis of AHF.Compared with NT-proBNP,serial sST2 testing appears to be a promising candidate for monitoring these patients.

BACKGROUNDThe plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) level is frequently elevated in dyspnoeic patients and increasingly used in emergency departments to assess the cause of acute dyspnea. In this study we prospectively tested NT-proBNP levels in patients with congestive heart failure (CHF) and/or acute pulmonary embolism (APE) and determined the utility of NT-proBNP for discriminating APE from CHF.

METHODSA cohort of 177 dyspnoeic patients with a diagnosis of APE and/or CHF was prospectively studied between June 2010 and March 2013. NT-proBNP was measured by the electrochemiluminescence immunoassay (ECLIA). All patients were evaluated with transthoracic echocardiography (TTE). APE was diagnosed in the presence of thrombi signs in the pulmonary arteries with computed tomographic pulmonary angiography (CTPA) or a high-probability lung ventilation/perfusion scan. Risk stratification was based on the evaluation on admission according to the ESC guidelines from 2008. The diagnosis of CHF was based on the guidelines of the American College of Cardiology/American Heart Association and the European Society of Cardiology. Two physicians independently reviewed the records to determine the final diagnosis.

RESULTSFifty-nine patients met the criteria for dyspnea caused by APE, and 113 patients were diagnosed with CHF. Most of the APE patients (41, 69.5%) were intermediate-risk. The symptoms and signs, such as orthopnea, paroxysmal nocturnal dyspnea and rales in the lungs, were more common in patients with CHF than in patients with APE (P < 0.01). Median NT-proBNP was significantly lower in patients with APE compared to those in patients with CHF (2 855.9 pg/ml vs. 6 911.4 pg/ml, P < 0.01). We constructed the receiver operating characteristics (ROC) curve in predicting the diagnosis of APE. At a cut point = 1 582.750 pg/ml, NT-proBNP provided a specificity of 93% and a true positive rate (sensitivity) of 17% for the diagnosis. At a cut point = 3 390.000 pg/ml, NT-proBNP had a specificity of 83% and a sensitivity of 84% for the diagnosis of APE. At a cut point = 6 486.500 pg/ml, they were 54% and 93% respectively.

CONCLUSIONSNT-proBNP can assist in excluding CHF patients from those admitted to the emergency department with acute dyspnea and identifying patients with a high probability of APE, which would reduce the missed diagnosis of APE. Larger studies are necessary to validate these findings.

Acute Disease ; Aged ; Aged, 80 and over ; Biomarkers ; blood ; Dyspnea ; blood ; Female ; Heart Failure ; blood ; diagnosis ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Prospective Studies ; Pulmonary Embolism ; blood ; diagnosis

Objective To explore the role of Beclin 1 and PTEN in gastric caicinoma genesis and the effects on prognosis.Methods The expression of Beclin 1 and PTEN in 199 gastric caicinoma specimens and corresponding adjacent noncancerous tissues were examined by tissue microarrays and immunohistochemistary,and the relation with gastric cancer was analyzed.The rate of Beclin 1 and PTEN expression in 15 fresh gastric carcinoma samples and corresponding adjacent noncancerous tissues were detected by Western blot.All the samples were from Changzheng Hospital.Results The Results of immunohistochemistary showed that the rates of Beclin 1 and PTEN positive expression in cancinoma tissues were 47.2％ (94/199) and 55.8％ (111/199),both were lower than that of adjacent noncancinoma tissues (94.5％,188/199 and 92.5％,184/199; P ＜ 0.01).The lower expression of Beclin 1 and PTEN in gastric carcinoma were associated with gender,differentiation degree,depth of tumor invasion,lymph node metastases and disease stage(P＜0.05).There was a positive correlation between Beclin 1 and PTEN expression in gastric carcinoma tissues (r =0.680,P＜0.01). The survival analysis indicated that Beclin 1 and PTEN were independent factors in determining the prognosis of gastric cancinoma patients.The 5-year survival rate of Beclin 1 positive patients was 67.0％ (63/94),and of negative patients was 33.3％ (35/105).The 5-year survival rate of PTEN positive patients was 71.2％ (79/111),and of negative patients was 21.6％ (19/88) ( all P＜0.001).The Results of Western blot indicated that the expression of Beclin 1 and PTEN in gastric carcinoma tissues were significantly lower than that in the adjacent noncarcinoma tissues ( all P＜0.001).Conclusion The abnormal expression of Beclin 1 and PTEN may be related to carcinogenesis and the development of gastric carcinoma.

Objective To investigate the influence of family support and personality characteristics on quality of patients' life who underwent total laryngectomy. Methods Patients (68 eases)who underwent total laryngectomy were surveyed with Su life of quality scale,Hu family support scale, Gong personality test and the results were sent for statistical analysis. Results Scores of two family groups in family support and quality of life underwent t test, physical function and psychological state were statistically different (P<0.05), living ability,social relations, tracheal stoma were statistically different(P<0.01). Persona lity and quality of life were subjected to single-factor analysis, psychological states were obviously related with four dimensions.Family support and personality characteristics score of two family groups underwent t test, E(internal and external quality),P(spiritual quality),N(nerval quality)were statistically significant (P <0.01 ). Condusions Family support and personality characteristics as the internal and external environmental factors directly affected patients who underwent total laryngectomy. Three-openfour-guiding-five-integrated-care-intervention measures can overall improve their quality of life.

Objective: To investigate the relationship between the Smad4-independent pathway of TGF-?1 and drug-resistance of pancreatic cancer. Methods: The sensitivities of Smad4 homozygous-deleted pancreatic cancer cell line BxPC3 to different kinds of anti-cancer drugs (5-Fu, Gemzar, Oxaliplatin, Cisplatin, CPT-11 and Epirubicin) were observed by MTT assay before and after they were transfected with full-length cDNA of TGF-?1 or treated with TGF-?1 (5 and 10 ng/ml) solution. Western blot was used to detect p170 protein expression after stimulation with different concentrations of TGF-?1. Results: Cisplatin had the most powerful killing effect on BxPC3 cells, followed by Oxaliplatin, 5-Fu and CPT-11 with moderate effect and Gemzar and Epirubicin with the least effect. Cells transfected with full-length cDNA of TGF-?1 or treated with TGF-?1 solution became less sensitive to Cisplatin. Western blot revealed upregulation of p170 expression by TGF-?1. Conclusion: The Smad4-independent pathway of TGF-?1 can increase the drug resistance of pancreatic cancer cells through upregulating expression of p170.